GU part 2

Question 1

using the UTI clinical decision aid, when would you empirically start to treat a UTI?

Answer 1

there are three factors:

1. pain with urination
2. leuks in urine (MORE than trace)
3. Nitrates in urine

if the patient has more than 2 points you would empirically treat and send for culture

if the patient has one point but in severe pain you can empirically treat

Question 2

UTI terminology, can you explain the difference between:

Recurrent
Re-infected
Relapse?

Answer 2

Recurrent: Two uncomplicated UTIs within 6 months or three or more positive urine cultures in the prior 12 months (3 utis one year or 2 complicated 6 month)

Reinfected: 2 weeks after completing abx therapy pt develops another UTI by a DIFFERENT organism

RELAPSE: 2 weeks after finishing tx pt develops UTI by the original organism

Question 3

What are you first line and second line abx tx for uncomplicated UTI?

Answer 3

TMP/SMX 1 tab BID
Trimethoprim 200mg
Nitrofurantonin (Macrobid) 100mg

second line

Amoxicillin
norfloxacin

Question 4

What is the duration of therapy for uncomplicated UTI

Answer 4

TMP/SMX and fluroquinolones = 3 days
macrobid = 5 days
amoxicillin and cephalexin = 7 days

Question 5

if a patient has relapse UTIs less than one month what are your first line med?

Answer 5

the same as before, but use a different one

remember relapse is reinfection with a different organism in less than one month

Question 6

What is the first and second line medication for child with UTI and what is the duration?

Answer 6

Duration is 7-14 days

First line: TMX/SMX (septra)

second line:
amoxicillin
Trimithoprim
cephalexin

Question 7

What is your first line treatment for a pregnant women with a UTI?

Answer 7

Cephalexin X7 day
Amoxicilin X7 days
nitrofuritonin X5 days

second line:
TMx/SMX (septra X3 days)
Trimethoprim X3 days

Nitrofurotin is contraindicated for women at term (36+ weeks)
Avoid TMX/SMX + Trimethprim in the first trimester AND last 6 weeks of pregnancy
No fluorqinolones in pregnancy

You cannot give ni

Question 8

What is your first line treatment in female UTI and what is the duration?

Answer 8

First line:
TMX/SMX, or trimethoprim X3 days
Nitrofurantoin X5 days
Fosfomycin one time dose

Second line:
amoxicillin X7 days
Norofloxacin x3 days

Question 9

What is a complicated UTI and what are the first line treatments?

Answer 9

complicated UTIs are male UTIs the duration of treatment is X7 days

First line:
TMP/SMX
Trimethoprim
Nitrofurantoin
Norfloxcin
Cirpofloxacin
Levofloxacine X 10 days